MEDICARE: DEER PARK ANESTHESIA GROUP, LLP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104866698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER PARK ANESTHESIA GROUP, LLP.

Provider Business Mailing Address
First Line	:	2 CATHARINE ST
Second Line	:	P.O. BOX 550
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-3100
Country	:	US
Telephone Number	:	866-885-2318
Fax Number	:	845-790-2675

Provider Business Practice Location Address
First Line	:	160 E MAIN ST
Second Line	:	BON SECOURS COMMUNITY HOSPITAL
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2253
Country	:	US
Telephone Number	:	845-858-7000
Fax Number	:	845-790-2675

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HUSSEIN OMAR
Credential	:	MD
Telephone Number	:	866-885-2318

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/21/2022

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